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With the accelerating process of climate change, long-term exposure to extreme temperatures could threaten individuals’ physical health, especially for the vulnerable population. This paper aims to investigate the long-term effects of extreme temperature exposure on the health of the elderly in the context of climate change and aging. Different from most of the existing literature in environmental economics, we define the relative extreme temperature exposure based on the local temperature pattern. By combining a large national household survey and nationwide meteorologic historical data, this study provides empirical evidence that heat exposure days and cold exposure days during the past year both significantly affect the physical health of middle-aged and elderly groups, controlling for city, year, and individual fixed effects. The effect on individual physical health has certain seasonal characteristics and is heterogeneous across populations. Additionally, cooling and heating equipment are effective in alleviating the reverse impact of heat and cold exposure. The estimation is robust and consistent across a variety of temperature measurements and model modifications. Our findings provide evidence of the long-term and accumulative cost of extreme temperature to middle-aged and elderly human capital, contributing to helping the public to better understand the full impact of climate change.

Background Vision health is an important aspect of health worldwide. Visual impairment (VI) is associated with poor quality of life and is usually more prevalent in rural areas. To help rural populations obtain vision care, health insurance policies have emerged throughout the world. However, some existing literatures show that health insurance enrollment’s impact on the overall physical health of rural population has been minimal. Focusing on vision health among adults in rural China, our study aims to investigates the impact of health insurance on vision health, heterogeneity of the effect, and the moderating effect of health insurance enrollment on the impact of chronic physical diseases and basic eye diseases on vision health. Methods Primary data were collected through a nation-wide epidemiological survey of vision health conducted in rural China in 2018, with a sample size of 28,787 used in our statistical analysis. Instrumental variables regression and Heckman selection models were conducted to examine the impact of health insurance enrollment and reimbursement ratio adults’ vision health outcomes. Subsample regressions by sex, age, education level, and whether with eye diseases were further conducted to explore the heterogeneity in our results. We then examined whether health insurance enrollment moderates the impact of chronic physical diseases and basic eye diseases on vision health through the method of introducing interaction terms. Results Participating in health insurance reduced the probability of VI by 2.15 %. The reimbursement rate increasing by 1 % point may reduce the probability of worsening VI by 6.12 %. Men (-0.0235, P = 0.0002) benefit more from insurance enrollment than women (-0.0201, P = 0.0082) with respect to vision health. From the young adult group to the oldest group, the marginal effect of health insurance increased from − 0.0068 (P = 0.0394) to -0.0753 (P P = 0.0033) benefit more from participating insurance than the people without basic eye diseases (-0.0196, P = 0.0001) with respect to vision health. The moderating effects of health insurance enrollment on the impacts of cerebral infarction (-0.1225, P P = 0.0245), hyperlipidemia (-0.1364, P = 0.0271), mental illness (-0.1873, P = 0.0010), glaucoma (-0.1369, P = 0.0073), diabetic retinopathy (-0.1560, P = 0.0043), and retinal vein obstruction (-0.2018, P = 0.0155) on vision health were significantly negative. Conclusions The results suggest that participation in health insurance and higher health insurance reimbursement ratios reduced the risk of VI in the sampled adults. Health insurance has the most significant effect in in vulnerable groups. Heath insurance enrollment moderates the impacts of several chronic physical and basic eye conditions on vision health. Our findings have potential implications for reforming health insurance policies to improve vision health conditions in rural areas of developing countries.

A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face 4 major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.

Background/aimTo quantify the impact of baseline presenting visual acuity (VA), refractive error and spectacles wear on subsequent academic performance among Chinese middle school children.MethodsA prospective, longitudinal, school-based study on grade 7 Chinese children (age, mean±SD, 12.7±0.5 years, range=11.1–15.9) at four randomly selected middle schools in Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were performed at baseline, and information on demographic characteristics, known risk factors for myopia and spectacle wear was collected. Academic test scores for all subjects in the curriculum were obtained from the local Bureau of Education. Main outcome measure was total test scores for five subjects at the end of grade 9, adjusted for total scored at the beginning of grade 7.ResultsAmong 2363 eligible children, 73.1% (1728/2363) had seventh grade test scores available. 93.9% (1623/1728) completed eye examinations, and 98.5% (1599/1623) of these had ninth grade test scores. Adjusting only for baseline test score, the following were significantly associated with higher ninth grade scores: younger age, male sex, less time outdoors, better baseline presenting VA, higher parental education and income and parental myopia, but refractive error and spectacle wear were not. In the full multivariate model, baseline test score (pConclusionsIn this longitudinal study, better presenting VA, but not cycloplegic refractive error or spectacle wear, was significantly associated with subsequent academic performance.

Mental health conditions such as depression is a rapidly rising epidemic and a major contributor to the overall global burden of disease. In addition to the direct medical costs and indirect economic costs that falls into the traditional boundary of disease burden estimation, many social costs associated with depression are hidden yet important. This paper provides empirical evidence on the existence of two hidden costs associated with depression: negative impact on social trust and life satisfaction. Based on the data obtained from 2012 China Family Panel Studies, our estimated results indicate that individuals who have a high tendency for depression or depressive symptoms are less likely to trust other people, and they also have significantly lower life satisfaction than their counterparts who are relatively mentally healthy. Given that trust is an important component of social capital, which in turn is an important input to foster economic growth in general and innovation in particular, the reduction in trust induced by the increasing prevalence of depression imposes a significant cost to the society in terms of poor economic performance. Similarly, as life satisfaction has been widely recognized as an important measure of well-being, our study also highlights that the increase in the prevalence of depression leads to a reduction in the well-being that individual can enjoy. All these costs are real, but did not receive sufficient attention in the previous research. The contribution of our research is to shed light on the existence of these hidden costs and to quantify the magnitude of such costs in the context of China.

Due to its fast economic growth and lifestyle changes, China is experiencing a rapid epidemiological transition from communicable to noncommunicable diseases (NCDs). Mental disorder such as depression is an important yet often neglected NCD and is becoming a growing cause of disability, suicides, and disease burden. This paper provides the first nationally representative estimate of the medical cost attributable to depression and depressive symptoms among the adult population in China. On the basis of the 2012 China Family Panel Studies survey, our results indicate that these mental health conditions have significant impacts on the individual medical expenditure, and they jointly contribute to 14.7% of total personal expected medical spending in China, with depression and depressive symptoms accounting for 6.9% and 7.8%, respectively. Given that patients with mental illness face multiple psychological and institutional barriers in seeking appropriate treatment, the high depression-induced medical costs may be primarily driven by the cost-shifting effect from mental health care to general health care, as mental disorders often coexist with other NCDs such as diabetes and hypertension. As an implication, our study calls for an urgent reform of China's mental health and insurance systems to remove the policy-induced obstacles for the access to mental health care resources.

This paper estimates the intergenerational health transmission in China using the 1991–2009 China Health and Nutrition Survey (CHNS) data. Three decades of persistent economic growth in China has been accompanied by high income inequality, which may in turn be caused by the inequality of opportunity in education and health. In this paper, we find that there is a strong correlation of health status between parent and their offspring in both the urban and rural sectors, suggesting the existence of intergenerational health inequality in China. The correlation is robust to various model specifications, including the control of unobserved household heterogeneity using instrumental variables. We also find that parents' socio-economic characteristics and environmental choices are strongly correlated with their own and their children's health, supporting the “nature–nurture interaction” hypothesis. The Blinder–Oaxaca decomposition further indicates that 15% to 27% of the rural–urban inequality of child health is attributable to the endowed inequality from their parents' health. An important policy implication of our study is that the increasing inequality of income and opportunity in China can be ameliorated through the improvement of the current generation's health status and living standards.

This paper examines whether participating in the New Rural Cooperative Medical Scheme (NRCMS), a publicly subsidised health insurance programme in rural China, encourages individuals to engage in risky health behaviours. Despite its rapidly increasing coverage rate, relatively little attention has been paid to the impact of NRCMS on the lifestyle choices of its enrollees. On the basis of the 2000–2009 longitudinal data from the China Health and Nutrition Survey (CHNS), we find that NRCMS participation has a statistically significant (although quantitatively small) impact on people’s tendency towards smoking, heavy drinking (among males), spending time in sedentary activities, consuming high-calorie food and being overweight. The increase in these unhealthy lifestyles in turn leads to elevated disease risks, indicating that insurance-induced, “ex ante moral hazard” is present in rural China. The findings are robust to the variation in model specification and sample selection, as well as to the introduction of an instrumental variable that controls the endogeneity of insurance participation. Our results provide implications on reforming the pricing and administration practice of China’s largest health insurance campaign and on evaluating public insurance schemes in other developing countries.

This article estimates the impacts of health information technology (HIT) on health-care delivery in the Wenchuan County of China, where the devastation of the 2008 Great Wenchuan Earthquake and the subsequent large-scale HIT implementation (the Healthy Wenchuan Program) offers a 'natural experiment' opportunity, enabling us to conduct a difference-in-difference evaluation of the potential benefits of HIT on accessibility, affordability and appropriateness of health-care services in the underdeveloped rural area. Based on data collected from two field surveys in township hospitals, we find that for both the inpatient and outpatient samples, the HIT system promotes access to medical care by increasing doctor referrals and encouraging within-county medical utilization, reduces patient financial burden in certain expenditure categories, and contributes to higher patient satisfaction on medical care quality. On the other hand, we also find that HIT leads to increased patient waiting time for hospital registration, reflecting the unique challenges in implementing HIT in the underdeveloped areas. Our study contributes to the growing body of literature on evaluating the impacts of HIT application in the developing regions, and provides implications on the potential role of HIT in China's national health system reforms.

The large and growing uninsured population poses an alarming threat to the US health care system, and is a major target of the Obama health reform. This paper investigates analytically and empirically the degree to which the absence of health insurance in the US reflects the availability of the health care safety net, such as the guaranteed or charitable care provided by emergency rooms, community health centers and physicians. Our theoretical model demonstrates that the safety net can be a real alternative to health insurance, thus discouraging private insurance purchase in the market setting. In particular, when the community premium rate fails to reflect the value of such resources, not purchasing insurance becomes a rational decision for a sizeable portion of the population. The calibrated simulation based on US statistics indicates about 15.75 % of the uninsured population, or 7.2 million people in US, are attributable to the existing safety net system. Further empirical analysis using nationally representative data shows consistently that the presence of local safety net resources may reduce the probability of individual insurance purchase by as much as 45.9 %.

Due to the rapid economic growth and advancement in medical technology, many countries have experienced in the past decades an epidemiological transition from communicable to non- communicable dieses (NCDs). One of the challenges in the era of NCDs is the large treatment gap, measured by the difference between the need for treatment and the actual provision of treatment, among patients with NCDs. This paper investigates the causes of treatment gap in mental healthcare from the perspective of economics. Specifically, we hypothesizes that people with mental illness face four major hurdles in seeking appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to the mental health sector, the high time prices due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We then use China as a study setting to show the country-specific evidence. Our analysis supports the above theoretical argument on the four access barriers, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.

Mental health conditions such as depression is a rapidly rising epidemic and a major contributor to the overall global burden of disease. In addition to the direct medical costs and indirect economic costs that falls into the traditional boundary of disease burden estimation, many social costs associated with depression are hidden yet important. This paper provides empirical evidence on the existence of two hidden costs associated with depression: negative impact on social trust and life satisfaction. Based on the data obtained from 2012 China Family Panel Studies, our estimated results indicate that individuals who have a high tendency for depression or depressive symptoms are less likely to trust other people, and they also have significantly lower life satisfaction than their counterparts who are relatively mentally healthy. Given that trust is an important component of social capital, which in turn is an important input to foster economic growth in general and innovation in particular, the reduction in trust induced by the increasing prevalence of depression imposes a significant cost to the society in terms of poor economic performance. Similarly, as life satisfaction has been widely recognized as an important measure of well-being, our study also highlights that the increase in the prevalence of depression leads to a reduction in the well-being that individual can enjoy. All these costs are real, but did not receive sufficient attention in the previous research. The contribution of our research is to shed light on the existence of these hidden costs and to quantify the magnitude of such costs in the context of China.